Denial of Coverage Problem

[BobJam]

Hopefully, some agent will be able to set me straight on this.

Here's the deal.

I am currently insured through my former employer (I'm retired) with an Aetna PPO policy, "Open Access Select". My Health Insurance has gone from $600/mo about five years ago up to what it is now: $900/month! (Amounts and time spans are approximate, but the point is that the cost has now become a substantial burden).

The carrier has gone from CIGNA to UnitedHealthCare, to Aetna as it is now.

I am 64, but my wife is 62.

The problem: I wanted to see if I could reduce the cost by dumping Aetna and purchasing a BCBS catastrophic policy (high deductible . . . BCBS was the cheapest by 100's of dollars!). The cost difference is about $500 dollars/month.

My wife has Alzheimers', which is listed on the BCBS catastrophic policy app as cause for denial. (I live in Arizona)

I spoke to an EHealth agent (where I found the BCBS policy) and he said that BCBS would deny the app since I already had coverage and wouldn't be compelled to approve it unless my wife lost her coverage "through no fault of her own" (which according to him meant that non-payment to Aetna or cancellation of the policy by me were out as remedies).

The Aetna policy will automatically cancel when I reach 65 and will then be covered by Medicare. But my wife will only be 63 at that time and hence not covered. However, according to the EHealth person, that will mean that my wife will have lost her coverage "through no fault of her own", so at that point I'm good to go.

But right now, and for the next twelve months, I seem to be locked into this thing at that high price (the employer has no other offering, so an alternative there is out . . . I already tried that route).

According to the EHealth person, there's no way out or any other alternative for me to get cheaper coverage right now.

I'm not familiar with the ins and outs of this circumstance, so right now I have to trust that the EHealth guy was correct. Was he?

Am I hosed for 12 months, or what?

 

[Crabcake Johnny]

The Ehealth agent is wrong. Whether or not you currently have group coverage has zero bearing on being accepted or denied an individual policy.

Your wife is unable to get any underwritten individual insurance product. I believe what the agent might have been trying to say is that if for some reason your group policy was canceled (by your former employer for example) that your wife would indeed qualify for guaranteed issue option but that doesn't seem to be in the cards.

 

[BobJam]

So you're saying that basically I'm hosed and will have to sustain the elevated group insurance cost for another twelve months?

I was planning on cancelling within 89 days of going on Medicare (because as I understand it, SS considers it to be "continuous coverage" and does not penalize for non-coverage within 90 days of eligibility), but if I want my wife to be eligible for catastrophic coverage (BCBS maybe) apparently I'm going to have to let it run right up until I'm 65 and expire itself?

 

[somarco]

eHealth agents are bozo's. Never believe anything they tell you.

Are you sure your group plan will cancel when you turn 65? Or will it become a supplement to Medicare?

Are you sure your wife will be cancelled at that time? Not saying it won't happen but that would be unusual. Most likely situation is she continues to age 65 on the retiree plan.

If she is booted off she should have a COBRA option and then HIPAA conversion.

Here are other options in AZ.

 

[Crabcake Johnny]

So you're saying that basically I'm hosed and will have to sustain the elevated group insurance cost for another twelve months?

I was planning on cancelling within 89 days of going on Medicare (because as I understand it, SS considers it to be "continuous coverage" and does not penalize for non-coverage within 90 days of eligibility), but if I want my wife to be eligible for catastrophic coverage (BCBS maybe) apparently I'm going to have to let it run right up until I'm 65 and expire itself?

I can only answer your question as it applies to your current situation before you turn 65 and using your words, yes, you are hosed.

You'll need to get with a very experience local agent regarding what will happen when you turn 65 and a call to your company's HR department regarding whether or not your plan will continue for your wife, as Somarco is stating, is something to do.

But you have zero options for your wife regarding getting her insured with any plan that requires underwriting.

 

[BobJam]

Are you sure your group plan will cancel when you turn 65? Or will it become a supplement to Medicare?

Yes, I'm sure it will cancel.

Are you sure your wife will be cancelled at that time? Not saying it won't happen but that would be unusual. Most likely situation is she continues to age 65 on the retiree plan.

Since she is covered under my plan, and it will no longer exist, I'm 99% sure she will no longer be covered. Nevertheless, I will call HR as healthagent suggests. Actually, it seems it would be just as well if she were no longer covered "through no fault of her own" anyway because then she would be eligible for catastrophic coverage.

My whole point in this exercise is to reduce the cost of coverage if possible.

If she is booted off she should have a COBRA option and then HIPAA conversion

But going on COBRA would defeat my purpose, because my goal is to reduce the cost and wouldn't COBRA coverage be the same cost as it is now?

What is a "HIPAA conversion"?

Here are other options in AZ.

Thanks for the link. I'll have to read all the stuff and get my arms around it.

Are you saying that I have some options to achieve my stated goal of reducing the cost in the next twelve months? Healthagent seems to think I don't.

While I certainly want her to be covered, my main goal is to reduce the costs. If I don't have any options there (for the next 12 months), I'll default to sustaining the current coverage (though I may be eating a lot of Top Ramen noodles).

 

[HealthGuy]

Bobjam man take healthagents advice and call a local health agent and stop trying to figure this out yourself. Find a local health insurance expert and do what he says.

 

[briko3]

Bobjam man take healthagents advice and call a local health agent and stop trying to figure this out yourself. Find a local health insurance expert and do what he says.

I agree with this. Why are you stressing so much when you can find a good local agent to help you out?

 

[HealthGuy]

Briko: I know why. Because this guy is a mechanical engineer and can figure everything out himself and is a health insurance expert too. You know the type. Its the type that wastes your time and then goes and buys direct. Its the health insurance do it yourselfer. Then when he gets a policy recission he calls you for help. In the quest to "save on costs" he Fs himself.
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Oh, and I forgot while guys like BobJam read every piece of information that he can get his hands on, he turns into an expert "researcher" that can't make up his mind....How are you doing with your overload of info BobJam?

 

[Guest]

I can relate. Retired and paying $1,700/mo for my me and my wife. Tried to replace this year with an individual policy and all applications (Blue Cross, Blue Shield and Aetna thru AARP) were denied because I fractured my femur less than a year ago.
Sorry to hear that your wife has Alzheimers but you may want to double check with HR at your former employer. The group policy may continue to insure to her until she reaches the age eligible for medicare.